White Plains Hospital Spine Services: Fostering Excellent Outcomes through Evidence-based, Collaborative Care

By Tiffany Parnell
Friday, January 12, 2018

The White Plains Hospital Center for Orthopedic & Spine Surgery team of fellowship-trained spine surgeons, physician assistants, pain management specialists, specially trained nurses, physical therapists and other professionals provides comprehensive nonsurgical and surgical care for conditions of the cervical, thoracic and lumbar spine, preventing the need for referral to larger, metropolitan facilities.

Andrew M. Casden, MD, Chief of Orthopedic & Spine Surgery at White Plains Hospital, and Jared Brandoff, MD, spine surgeon at White Plains Hospital, both previously practiced at well-known New York academic medical centers. At White Plains Hospital Center for Orthopedic & Spine Surgery, they perform the most common to the most complex spinal procedures.

Back pain, especially low back pain, places a significant burden on patients and primary care physicians. Low back pain is the No. 1 cause of job-related disability and one of the most common causes of missed workdays, according to the National Institute of Neurological Disorders and Stroke. Additionally, a 2013 study published in JAMA found that back and neck pain account for $86 billion in annual healthcare expenditures and 10 percent of primary care physician visits.

The White Plains Hospital Center for Orthopedic & Spine Surgery team helps patients find relief from a variety of spinal conditions that can greatly reduce quality of life, including radiculopathy, scoliosis, herniated discs, fractures, spondylolisthesis and spinal stenosis. Treatment modalities range from medication and physical therapy to injections and, when indicated, surgical intervention.

Dr. Casden reviews a patient file with Geraldine DeGuzman-Javier, an orthopedic physician assistant at White Plains Hospital Center for Orthopedic & Spine Surgery.

Establishing the Appropriate Course of Treatment

When patients first present with back pain, sciatica or other symptoms related to a spinal condition, White Plains Hospital providers, including physical therapists, pain management specialists and physician assistants, perform a detailed evaluation. Patients may also undergo diagnostic tests, such as X-ray, MRI, CT scanning, nerve conduction testing, discography and myelography, to assist the team’s decision-making.

“We employ a patient-centered approach to care and listen closely to patient concerns,” says Jared Brandoff, MD, spine surgeon at White Plains Hospital. “This ensures we not only diagnose patients properly, but also develop a comprehensive plan to treat them in ways that achieve their short- and long-term goals and improve their quality of life.”

In nearly all cases, physicians recommend conservative approaches before moving forward with surgical intervention.

“Nonoperative management is the first line of treatment unless there are extenuating circumstances, such as the presence of weakness, difficulty walking, and bowel or bladder dysfunction,” says Andrew M. Casden, MD, Chief of Orthopedic & Spine Surgery at White Plains Hospital. “For most patients, the decision to have surgery is a quality-of-life decision. If pain is uncontrolled with nonoperative approaches, or if patients begin having trouble dressing and performing other activities of daily living, surgery becomes a consideration.”

As part of White Plains Hospital’s recent expansion, five new operating suites offer the most advanced surgical technology and equipment, designed for the most complex procedures, including minimally invasive surgeries.

Meet Drs. Casden and Brandoff

Andrew M. Casden, MD, Chief of Orthopedic & Spine Surgery at White Plains Hospital, has practiced spine surgery for more than 25 years. Prior to joining the White Plains Hospital team, Dr. Casden served as an associate professor of orthopedics at Mount Sinai Medical Center in New York City.

He holds a medical degree from Cornell University Medical College. He performed his surgical residency at NewYork Hospital/Cornell Medical Center and his orthopedic surgery residency training at the Hospital for Joint Diseases Orthopaedic Institute before completing a spine fellowship at Rush-Presbyterian-St. Luke’s Medical Center in Chicago. Dr. Casden is a board-certified orthopedic surgeon and Fellow of the American Academy of Orthopaedic Surgeons.

Jared Brandoff, MD, spine surgeon at White Plains Hospital, cares for adolescent and adult patients and specializes in the management of all diseases affecting the cervical, thoracic and lumbar spine.

A Fellow of the American Academy of Orthopaedic Surgeons, Dr. Brandoff holds a medical degree from New York Medical College. He completed his general and orthopedic surgery residencies at Long Island Jewish Medical Center before performing fellowship training in spine surgery at the Spine Institute of New York–Beth Israel Medical Center.

Scientifically Validated Techniques

The most common procedure White Plains Hospital spine surgeons perform is discectomy, according to Dr. Casden. Discectomy helps relieve symptoms related to herniated discs, including referred pain in the arm or leg, numbness, tingling and weakness, by removing fragments of the damaged or bulging disc that is placing pressure on the spinal cord.

White Plains Hospital Center for Orthopedic & Spine Surgery spine surgeons combine time-tested procedures with the latest proven, research-based techniques to enhance patient outcomes. Many of the spinal surgeries offered at White Plains Hospital, including discectomy, are performed in a minimally invasive fashion through smaller incisions and, when necessary, with the use of advanced technologies, such as intraoperative CT scanning. When indicated, minimally invasive surgeries offer several benefits, including quicker recoveries.

“With these less-invasive approaches, patients get rapid relief from their pain and are able to resume their normal lives within a shorter amount of time,” Dr. Casden says. “For example, many patients go home the same day as surgery and benefit from faster returns to work and other activities, including sports.”

Even though the Hospital’s spine team is committed to performing the least-invasive surgeries possible, some cases warrant open surgery. White Plains Hospital spine surgeons are skilled in both minimally invasive and open approaches, which ensures patients benefit from the surgical option that will yield the best outcome.

“We do everything with an eye toward superior outcomes,” Dr. Brandoff says. “‘Minimally invasive’ is an important concept in medicine right now, but that doesn’t mean it’s always the preferable technique. We deliver care in the least invasive way possible to spare the tissues as much as we can and to ensure the fastest possible recovery, but without neglecting the principles of surgery and the problems that require patients to need surgery in the first place.”

“We are comfortable taking care of all pathologies — from the most routine to the most complex — in ways that are time-tested and scientifically proven and, most importantly, make patients feel comfortable. There’s no need to send patients outside of the community for care because equivalent care is available right here in patients’ backyards.”
— Jared Brandoff, MD, spine surgeon at White Plains Hospital

Spine surgeon Dr. Brandoff consults a postoperative patient in White Plains Hospital Center for Orthopedic & Spine Surgery’s dedicated unit, where a team of highly trained nurses and staff cares for patients.

Expert Care for Complex Cases

In some cases, patients who’ve undergone a spine procedure require revision surgery if the original surgery was unsuccessful in relieving symptoms or if patients developed surgical complications. For example, some patients develop significant symptoms years after their procedures due to spinal deformities developing above or below the level on which surgeons originally operated, a problem known as pseudarthrosis.

Revision surgeries may include spinal fusions, surgery to realign the spine or surgery to manage aging spine degeneration. These surgeries are complex and require specialized knowledge. Physicians who perform revision surgery must not only recognize why surgery is necessary but also know what the patient is hoping to achieve after surgery and understand the complexities of reoperating on the spine. At White Plains Hospital, Dr. Casden performs complex revision spine surgery as indicated.

“White Plains Hospital spine surgeons live and work in the area and are intimately involved in the communities in which we practice medicine. We have completed well-respected fellowship programs and offer expert patient care featuring the latest approaches.”
— Andrew M. Casden, MD, Chief of Orthopedic & Spine Surgery at White Plains Hospital

Physician assistants specially trained in orthopedics work closely with surgeons, nurses and staff to deliver comprehensive care to our patients from consult, to surgery, if needed, and recovery.

Optimizing Health before and after Surgery

The team works collaboratively to prepare patients for surgery, provide up-to-date perioperative care and streamline access to postsurgical follow-up. Prior to surgery, for example, spine surgeons work closely with the spine surgery coordinator and patients’ primary care physicians to help patients optimize their health through smoking cessation, weight loss and management of comorbid conditions, such as diabetes and high blood pressure.

At our physicians’ practice in West Harrison, just minutes from the Hospital, patients can expect the same exceptional care from our team. Seen here (L-R) are Brittany Hurley, Katia Becediche, Denise Stevens and Julissa Garita.

To ensure patients benefit from high-level perioperative care, White Plains Hospital has implemented enhanced recovery after surgery (ERAS) protocols. These protocols outline best practices for several elements of care, including nutrition, the use of minimally invasive techniques and early mobilization. According to a 2017 JAMA Surgery study, ERAS protocols reduce hospitalization time by 30 to 50 percent and offer similar reductions in complication rates.

At all points in the care process, patients also benefit from multidisciplinary collaboration. Robust availability of physicians and physician assistants means the physician practices can often accommodate same-day appointments with rapid MRI access to expedite the initiation of treatment.

Before and after surgery, physicians and physician assistants work closely to manage patients and keep referring physicians apprised of patient progress. During surgery, two board-certified spine surgeons are present at all times. Following surgery, patients begin physical therapy as soon as possible, and physician assistants are readily available to manage postoperative care.

White Plains Hospital has recently renovated and expanded its facilities, offering greater amenities for patients, including a welcoming entrance and lobby, new patient tower featuring 24 private rooms, and a conveniently located cafe.

For patients, close communication among providers means streamlined care, enhanced satisfaction, and greater continuity of care after surgery because the same physician assistants who oversee nonoperative management provide postoperative care in the hospital and on an outpatient basis. This collaboration helps referring physicians remain fully involved in patient care.

“Referring physicians are the lifeblood of our practice, and we see ourselves as a vehicle or tool to make their practice easier,” Dr. Brandoff says. “Our goal is to confidently care for patients and return them in good condition, so physicians know they have a reliable partner to turn to for help in managing their patients’ pain.”

For more information about White Plains Hospital’s orthopedic and spine services, visit wphospital.org/orthopedics.